Provider Demographics
NPI:1710260690
Name:MAHONEY, LESLIE MARIA (BA)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:MARIA
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5741 CORNELISON RD
Mailing Address - Street 2:6400 BUILDING
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-5661
Mailing Address - Country:US
Mailing Address - Phone:423-954-8890
Mailing Address - Fax:423-954-8880
Practice Address - Street 1:5741 CORNELISON RD
Practice Address - Street 2:6400 BUILDING
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5661
Practice Address - Country:US
Practice Address - Phone:423-954-8890
Practice Address - Fax:423-954-8880
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health